Tunthanathip Thara, Phuenpathom Nakornchai
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand.
J Neurosci Rural Pract. 2017 Oct-Dec;8(4):601-608. doi: 10.4103/jnrp.jnrp_381_17.
Motor vehicle is a major transportation in Southern Thailand as the result of road traffic injury and death. Consequently, severe disability and mortality in pediatric traumatic brain injury (TBI) were observed from traffic accident, particularly motorcycle accident. To identify the risk of intracranial injury in children, the association of treatment outcome with various factors including mechanisms of injury, clinical characteristics, and intracranial pathology can be assessed.
This was a retrospective study conducted on children, who were younger than 15 years old with TBI and were enrolled from 2004 to 2015. Several clinically relevant issues were reviewed and statistically analyzed.
A total of 948 casualties were enrolled. Compared with falling down, the motorcycle accident was significantly associated with intracranial injury (odds ratio 1.73, 95% confidence interval [CI] 1.08-2.76). Other factors associated with intracranial injury were hemiparesis (odds ratio 5.69, 95% CI 1.44-22.36), positive of basal skull fracture signs (odds ratio 15.66, 95% CI 3.44-71.28), and fixed reaction to light of both pupils (odds ratio 5.74, 95% CI 1.71-19.23). Mortality found in thirty cases (3.2%). Furthermore, the risk of death correlated with motorcycle accident ( = 0.02) and severe head injury ( < 0.001). Neurosurgical intervention was not associated with outcome, but severe head injury, hemorrhagic shock, epidural, and subdural hematoma were impact factors.
The findings demonstrate road traffic injury, especially motorcycle accident leading to brain injury and death. Prevention program is a necessary key to decrease mortality and disability in pediatric TBI.
由于道路交通事故伤亡，机动车是泰国南部的主要交通工具。因此，在交通事故尤其是摩托车事故中观察到小儿创伤性脑损伤（TBI）导致的严重残疾和死亡。为了确定儿童颅内损伤的风险，可以评估治疗结果与各种因素（包括损伤机制、临床特征和颅内病理）之间的关联。
这是一项对2004年至2015年期间纳入的15岁以下TBI儿童进行的回顾性研究。对几个临床相关问题进行了回顾和统计分析。
共纳入948名伤亡者。与跌倒相比，摩托车事故与颅内损伤显著相关（优势比1.73，95%置信区间[CI]1.08 - 2.76）。与颅内损伤相关的其他因素包括偏瘫（优势比5.69，95%CI 1.44 - 22.36）、颅底骨折体征阳性（优势比15.66，95%CI 3.44 - 71.28）以及双侧瞳孔对光固定反应（优势比5.74，95%CI 1.71 - 19.23）。30例（3.2%）发现有死亡情况。此外，死亡风险与摩托车事故（P = 0.02）和重度颅脑损伤（P < 0.001）相关。神经外科干预与预后无关，但重度颅脑损伤、失血性休克、硬膜外和硬膜下血肿是影响因素。
研究结果表明道路交通损伤，尤其是摩托车事故会导致脑损伤和死亡。预防计划是降低小儿TBI死亡率和残疾率的必要关键。
